The Washington University (WU) and BJC Prevention Epicenter (PE) works collaboratively with CDC and other PEs to perform research and to translate basic, epidemiology and technologic discoveries into new strategies to prevent and decrease healthcare associated infections (HAIs) and antimicrobial resistance (AR). The WU PE is internationally recognized for research productivity and leadership in HAI and AR prevention. WU has outstanding research infrastructure and ranks in the top medical centers in the U.S. BJC is a 13- hospital integrated healthcare delivery system including two ?top 10? academic hospitals. For our core and 3 multicenter collaborative proposals, we organized a team of basic, translational and clinical investigators with expertise in infectious disease, healthcare epidemiology, microbiology, AR, microbiome, and metabolome sciences to work together performing translational studies to prevent HAIs and AR. We propose a broad 4 year research strategy in our core proposal focused on developing and testing novel strategies to: document and improve outpatient antibiotic prescribing practices, reduce surgical site infections (SSIs), identify changes in AR and gut microbiome following fecal microbiome transplant (FMT), and identify novel biomarkers to more rapidly diagnose urinary tract infections and avoid unnecessary antibiotics in asymptomatic bacteriuria. To achieve these goals in our core proposal, we propose the following Specific Aims: 1. Determine antibiotic prescribing practices among dentists in the US utilizing Express Scripts Inc, a large pharmacy benefits manager database; 2. Reduce SSI after colorectal surgery with an enhanced recovery bundle, and implementation and expansion of a comprehensive care package; 3. Enhance an existing mastectomy SSI risk prediction model for individual women using clinical information from the electronic health record (EHR) and integrate the enhanced risk prediction model into the EHR for use by surgeons to communicate individualized SSI risk and to optimize SSI preventive practices for women undergoing mastectomy; 4. Determine the impact of fecal microbiome transplant (FMT) administered to patients with recurrent Clostridium difficile infection (CDI) on intestinal multidrug resistant organism (MDRO) colonization from specimens collected for a double blinded, dose response, randomized controlled trial; 5. Identify metabolomic biomarkers of high-risk bacteriuria in hospitalized patients. We are also submitting 3 proposals to lead small, medium and large collaborative projects with the Duke, Univ. of Pennsylvania and Hektoen/Rush PEs as participants in our multicenter proposals.